Everything you ever wanted to know about skin

(WALL STREET JOURNAL) Do I really need to cleanse, tone and exfoliate?

Your skin functions as a protective barrier, preventing pollutants and microbes from entering, and too much moisture from escaping. Using a cleanser to remove dirt and excess oil is a good idea in principle, but removing too much oil can be damaging. Soap and water is too harsh for most skin types, so use a gentle moisturising cleanser instead.

Although toning implies an improvement in skin quality, many dermatologists consider it unnecessary. Similarly, although exfoliating may leave your skin feeling smoother in the short term, if – like around 50% of the UK population – you have sensitive skin, it could aggravate it. “You would never hear a dermatologist telling you to cleanse, tone and exfoliate,” saysWal Hussein, consultant dermatologist at Leeds Teaching Hospitals NHS Trust and a spokesman for theBritish Association of Dermatologists. Neither are exfoliators much good for blackheads; pores that have become clogged with oil and dead skin cells. This process tends to occur from the bottom up, so using an exfoliator to slough off the top layer of skin won’t tackle their root cause: “You’re removing cells from the wrong place,” says Hussein. It is far better to apply a product that contains salicylic acid or benzoyl peroxide, which soften the blackhead and encourage it to free itself.

Should I invest in an expensive anti-ageing moisturiser?

Most dermatologists agree that moisturiser is a good idea, but it doesn’t have to be expensive. Look for one that contains glycerin, glycerol or hyaluronic acid – substances that attract water – and if you have acne-prone skin, use a mosturiser that is “non-comedogenic” (one formulated so as not to block pores). As for wrinkles, the gold standard are topical retinoids – vitamin A derivatives that help to unclog pores and boost collagen production, leading to plumper skin. “If someone has very early signs of skin ageing, I recommend a prescription for Retin A cream or gel every other night or two nights a week, and then an inexpensive night-time moisturiser to counter any drying effects,” saysNick Lowe, director of the Cranley Clinic for Dermatology in London. “And then every morning they should put on a broad-spectrum suncream, which also acts as a moisturiser.”

Retinoids are available only on prescription as they can irritate the skin. As for other anti-ageing ingredients, all cosmetic products must be safe and effective in order to receive European marketing approval: the question is how effective? “There is some data behind all these products, but none of them is a miracle cure,” says Hussein. If you are going to splurge on an anti-ageing cream, opt for one you apply at night. “The skin barrier seems to repair itself more efficiently at night, when you are sleeping,” adds Lowe.

Generally speaking, you’ll get more bang for your buck by applying sunscreen to your face and not smoking. “Most signs of skin ageing are a consequence of UV or sun exposure,” saysTamara Griffiths, a consultant dermatologist at Salford Royal NHS Trust, and a spokeswoman for the British Association of Dermatologists. Although some moisturisers contain sunscreen, most of us aren’t using enough of it for it to function as an effective barrier. “If you really care about sun protection, you should be using a separate product,” says Hussein.

Should I ever squeeze a spot?

The standard answer is no. “There is a risk this could damage the underlying skin, causing scarring or infection,” says Griffiths. But, she admits: “Spots can be squeezed or expressed with neither of these adverse events occurring.” If you are going to squeeze, wait until your spot has formed a white or yellow head, then disinfect a needle, prick the surface, wrap your fingers in tissue paper andgently squeeze from the sides. Stop if blood or clear fluid starts to come out.

Why do I still get spots in middle age?

Your oil glands are under the control of hormones, particularly testosterone – which women also produce in small quantities. “In around 25% of people who had acne or spots as a teenager, it comes back in adult life, and it tends to be more common in women,” says Lowe. Whereas testosterone tends to decline as men get older, in women, it is balanced by oestrogen, and this fluctuates with the menstrual cycle, after pregnancy, if you take the pill, and during the menopause. Any of these things trigger spots in adulthood. Stress, too, can alter the balance of hormones and cause spots in men and women.

Do some foods make spots more likely?

High GI foods, such as white bread or sugary fruits, can trigger acne in susceptible people, by altering the balance of hormones such as insulin. But the evidence is mixed and by no means certain, says Hussein. “I have a lot of patients who say: ‘Every time I eat this type of food, my skin gets oilier and my spots get worse’, and I say to them: ‘That’s fine, stop eating it’.” However, there are no conclusive statements that can be made about food and acne, he adds.

Should I see a GP if I get a rash?

Any rash that causes unpleasant symptoms such as redness and itching, or that you are worried about, should be seen by a GP. “Not all skin conditions can be cured, but there are treatments to contain, manage and control most of them,” says Griffiths. See a doctor if you notice any changes in moles and other pigmented areas of skin, or if you have a sore that isn’t healing.

Why does cold weather affect my skin?

Cold winds can damage the skin’s surface, impairing its barrier function, as well as boosting the rate at which moisture evaporates from it. This can leave us more prone to dry, sensitive skin and eczema. These conditions can also be aggravated by central heating. Drying soaps and detergents can make the skin’s condition even worse, but a rich moisturiser can help to protect it. Sun exposure tends to dampen the activity of immune cells in the skin and has an anti-inflammatory effect, which is why people with eczema and psoriasis often notice an improvement during the summer months. On the other hand, the immunosuppressant effect of the sun can also trigger cold sores to emerge,” Griffiths points out.

Do sunscreens lead to vitamin D deficiency?

If you slather yourself in sunscreen and rarely go outside, perhaps. But few people apply enough sunscreen to achieve anywhere near the SPF advertised on the bottle. If you wear it on your face to prevent wrinkles, expose your hands and arms to the sun instead – but never long enough for them to start turning red. Also, if you live in the UK,consider vitamin D supplements between November and March, when the British sun isn’t strong enough for our skin to manufacture vitamin D.